Neurology Flashcards
1
Q
What is myasthenia gravis?
A
Autoimmune neuromuscular disease characterised by muscle weakness
2
Q
Age groups affected by myasthenia graves
A
Young females, older men
3
Q
Pathophysiology of myasthenia gravis
A
Autoantibodies against post-synaptic acetylcholine receptors
4
Q
Sx myasthenia gravis
A
Fatigability
Ptosis, diplopia, difficulty standing and chewing
5
Q
Mx myasthenia gravis
A
Acetylcholinesterase - pyridostigmine
6
Q
Drugs to avoid in myasthenia gravis
A
B Blockers
lithium
phenytoin
7
Q
What is MS?
A
Degenerative disease of CNS caused by inflammation and demyelination
8
Q
Sx MS
A
Visual - optic neuritis Sensory - paraesthesia and trigeminal neuralgia Motor - spastic weakness Cerebellar - ataxia and tremor Urinary incontinence and fatigue
9
Q
Dx MS
A
MRI brain - sclerotic plaques
10
Q
Mx MS
A
B-interferons
11
Q
What is Huntington’s
A
Autosomal dominant condition caused by repeats of CAG
12
Q
Sx Huntington’s
A
Cognitive - dementia, behavioural changes
Chorea, dystonia, dysarthria
13
Q
Tx chorea
A
Tetrabenazine and benzodiazepines
14
Q
Tx bradykinesia
A
Levodopa
15
Q
Tx depression
A
SSRI
16
Q
What is Parkinson’s disease?
A
Neurodegeneration of dopamine neurones in substantia nigra
17
Q
Sx Parkinson’s
A
Bradykinesia
Tremor at rest
Rigidity
Depression
18
Q
Mx Parkinson’s
A
Levodopa
19
Q
Torticollis
A
Systained muscular contraction of neck
20
Q
Akathisia
A
Restlessness
21
Q
Febrile convulsions
A
Children 6m-5y, occur due to viral infection, brief and tonic-clonic in nature
22
Q
Alcohol withdrawal seizures
A
Decreased inhibitory GABA and increased NMDA glutamate due to cessation of drinking, normally 36h after
23
Q
Non-epileptic seizures
A
No characteristic electrical discharges
24
Q
Focal seizures
A
Start in a specific area of the brain
25
Generalised seizures
Both sides of brain, lose consciousness, lots of sub-types like tonic-clonic and typical absence
26
Infantile spasms
Flexion of head, trunk and limbs, last 1-2 seconds, mental handicap, due to neurological abnormality
27
Simple partial seizures
Focal and aware
28
Complex partial seizures
Focal and impaired
29
Temporal seizure sx
Hallucinations and automatisms
30
Frontal lobe seizure sx
Motor - head/leg movements
31
Parietal lobe seizure sx
Paraesthesia (sensory)
32
Occipital lobe seizure sx
Floaters/flashes
33
first line treatment for generalised seizures
sodium valproate
34
second line treatment for generalised seizures
lamotrigine
35
first line treatment for focal seizures
carbamazepine
36
second line treatment for focal seizures
sodium valproate
37
what is a hypnagogic jerk
just as you are about to fall asleep
38
what should you do if seizure lasts more than 10 mins
benzodiazepine - diazepam under tongue
39
Acute closed angle glaucoma sx
- Severe pain - ocular or headache
- Decreased visual acuity
- Sx worse with mydriasis
- Hard/red eye
- Non-reacting pupil
- Systemic upset - nausea/vomiting/abdo pain
40
treatment of acute closed angle glaucoma
- Parasympathomimetic - pilocarpine - increases outflow
| - B-blocker - propanolol - decreases humour production
41
Alzheimer's pathophys
Mutations in amyloid precursor proetin (chr21), presenilin 1 (chr14) and presenilin 2 (chr1) are risk factors
Macroscopic changes:
- Cerebral atrophy - cortex and hippocampus
Microscopic changes:
- AB plaques and tau tangles
42
medical treatment Alzheimer's
Acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) for mild-moderate
43
Where is the lesion in wernicke's aphasia?
Superior temporal gyrus - supplied by inferior MCA
44
sx wernicke's
pt has fluent speech but no meaning - comprehension is impaired
45
Where is the lesion in Broca's aphasia
Lesion in inferior frontal gyrus (supplied by superior left MCA)
46
sx Broca's aphasia
normal comprehension but can’t speak
47
conduction aphasia
speech is fluent but repetition is poor, comprehension is normal
48
area of brain affected by conduction aphasia
arcuate fasiculus
49
global aphasia
severe expressive and receptive aphasia
50
what is arnold-chiari malformation
Downward displacement/herniation of cerebellar tonsils through foramen magnum
51
Sx Bell's palsy
- LMN facial nerve palsy - forehead affected
- Post-auricular pain
- anterior 2/3 tongue (cn7)
52
which CN is affected in Bell's palsy
7
53
tx Bell's palsy
- Prednisolone within 72h
| - Refer to ENT if 3 weeks with no improvement
54
erb's palsy
- Damage to C5-6 roots
- Winged scapula
- May be caused by breech presentatio
55
klumpke's palsy
- Damage to T1
- Loss of intrinsic hand muscles
- Forearm supinated, wrist and fingers flexed
56
are brain lesions contralateral or ipsilateral
contralateral
57
parietal lobe lesion
sensation changes, inferior homonymous quadrantopia
58
occipital lobe lesion
homonymous hemianopia, cortical blindness
59
temporal lobe lesion
wernicke's aphasia, superior homonymous quadrantopia
60
frontal lobe lesions
Broca's aphasia, anosmia
61
cerebellar lesions
DANISH
62
amygdala lesion
Kluvery-Bucy = hypersexuality and agnosia
63
syndromes associated with pituitary adenoma
Benign tumours of pituitary gland, cause Cushing’s (ACTH) or acromegaly (GH) and bitemporal hemianopia
64
most common tumour in kids
astrocytoma
65
most common brain tumour in adults
glioblastoma multiforme
66
symptoms of brown-sequard syndrome
Ipsilateral weakness and loss of proprioception and vibration
Contralateral loss of pain and temp
67
sx cerebellar lesion
- D = dysdiadochokinesia
- A = ataxia
- N = nystagmus (horizontal)
- I = intention tremor
- S = slurred speech
- H = hypotonia
68
are cerebellar lesions contralateral or ipsilateral
ipsilateral
69
sx cerebral palsy
- Abnormal tone
- Delayed motor milestones
- Abnormal gait
- Learning difficulties
- Epilepsy
70
charcot-marie tooth syndrome sx
- Foot drop
- High-arched feet
- Hammer toes
- History of frequently sprained ankles
71
tx fibromyalgia
duloxetine or fluoxetine
72
tx neuropathic pain
gabapentin or amitriptyline
73
what is Creutzfeldt-Jakob disease
rapidly progressive neurodegeneration due to prion dementia
74
vascular dementia features
Cognitive impairment secondary to haemorrhage/ischaemia
75
vascular dementia sx
Stepwise deterioration, focal abnormalities, difficulty with attention, gait/memory/speech disturbance
76
Alzheimer's disease sx
Memory loss, poor judgement, getting lost, losing things
77
fronto-temporal dementia features
Atrophy of frontal or temporal lobes
78
fronto-temporal dementia sx
Onset <65, personality changes, preserved memory, delusions, PICK’S DISEASE
79
lewy-body dementia features
Build up of a-synuclein at pre-synaptic terminal = severe acetylcholine decline
80
lewy-body dementia sx
Progressive impairment, develops before Parkinson’s, visual hallucinations, depression
81
drugs causing peripheral neuropathy
```
amiodarone
isoniazid
vincristine
nitrofurantoin
metronidazole
```
82
pathophysiology of muscular dystrophy
X-linked recessive disorders due to a mutation in the gene encoding dystrophin (Xp21) which normally connects muscle membrane to actin
83
Duchenne muscular dystrophy
More severe
Progressive proximal muscle weakness from 5 y/o
Gower's sign
84
Becker's muscular dystrophy
Less sevre
| >10 y/o
85
organism associated with Guillain barre
campylobacter jejune
86
sx guillon barre
- Progressive, symmetrical weakness of all limbs
- Weakness is ascending (legs affected first)
- Sensory sx are mild
- CN involvement
- Respiratory muscle weakness
- Urinary retention and diarrhoea
87
extradural haemorrhage
Blow to side of head = MMA rupture, pt experiences lucid interval
88
subdural haemorrhage
Banana shaped haemorrhage, rupture of bridging veins, alcohol related
89
subarachnoid haemorrhage
Sudden, thunderclap occipital headache, ruptured berry aneurysm
90
Kluvery bucy sybndrome
hyper sexuality , increased appetite
91
Herpes simplex encephalitis
HSV1 infects temporal/occipital lobes
92
Herpes simplex encephalitis sx
- Fever
- Headache
- Psychiatric sx
- Seizures
- Vomiting
- Aphasia
- CSF: lymphocytosis and elevated protein
93
treatment for herpes simplex encephalitis
acyclovir
94
sx Horner's
ptosis, miosis and anhidrosis
95
post-ganglionic Horner's
no anhidrosis
| Carotid artery dissection, carotid aneurysm, cavernous sinus thrombosis
96
pre-ganglionic Horner's
anhidrosis of face
| Thyroidectomy/trauma
97
central Horner's
anhidrosis of face, arms and trunk
| stroke, syringomelia, MS
98
Huntington's pathophys
Autosomal dominant repeat expansion of CAG → degeneration of cholinergic and GABAergic neurons in basal ganglia
Defect in huntingtin gene on chr4
99
Huntington's sx
- 35+
- Chorea
- Personality changes
- Dystonia
- Saccadic eye movements
100
idiopathic intracranial hypertension
young, overweight females
r/f = female, obese, pregnant, COCP/steroids
Sx = headache, papilloedema, blurry vision
101
Lateral medullary syndrome
- Wallenberg’s syndrome
- Occlusion of posterior inferior cerebellar artery
- Ataxia and nystagmus
- Ipsilateral dysphagia, facial numbness and cranial nerve palsy
- Contralateral limb sensory loss
102
intracranial venous thrombosis sx
- Headache
- N and V
- Reduced consciousness
- +/- high d-dimer
103
tx intracranial venous thrombosis
anticoagulants
104
pathophys Lambert-eaton syndrome
Associated with small cell lung cancer or independently as autoimmune disorder
Antibody directed against voltage-gated calcium channels in PNS
105
sx lambert eaton
- Repeated muscle contraction = increased muscle strength
- Limb-girdle weakness (lower limb first)
- Hyporeflexia
- Autonomic sx - dry mouth, impotence etc
106
Sx MND
- Fasciculations
- Absence of sensory sx
- Both UMN and LMN lesions
- Wasting of hand muscles
107
most common type of MND
amyotrophic lateral sclerosis
108
myasthenia gravis pathophys
antibodies to acetylcholine receptors
109
sx myasthenia gravis
fatigue
diplopia and ptosis
muscle weakness
thymoma
110
mx myasthenia gravis
acetylcholinesterase inhibitors (pydifostigmine) and immunosuppression (prednisolone
111
sx normal pressure hydrocephalus
urinary incontinence, dementia and gait change
112
what is normal pressure hydrocephalus
A reversible cause of dementia secondary to reduced CSF re-absorption at arachnoid villi
113
tx normal pressure hydrocephalus
shunting
114
pathophys Parkinson's disease
Neurodegeneration of dopaminergic neurones in substantia nigra
115
sx Parkinson's
bradykinesia, resting tremor and rigidity
116
dx Parkinson's
SPECT CT
117
tx parkinson's
levodopa
118
pharmacological causes of Parkinson's
antipsychotics and metoclopramdie
119
how to calculate cerebral perfusion pressure
MAP - ICP
120
reflex changes with sciatic nerve lesion
Ankle and plantar reflex lost but knee jerk intact
121
What is thoracic outlet syndrome?
Compression of brachial plexus, subclavian artery/vein at site of thoracic outlet
Occurs due to neck trauma or cervical rib
122
sx thoracic outlet sundrome
paraesthesia, wasting of hand muscles, oedematous arms
123
What is a TIA
Transient episode of neurologic dysfunction caused by brain, spinal cord or retinal ischaemia without acute infarction
124
sx TIA
RESOLVE <1hr
- Unilateral weakness/sensory loss
- Aphasia or dysarthria
- Ataxia/vertigo/balance issues
- Visual changes
125
Tx TIA
Immediate aspirin 300mg
| Clopidogrel after this
126
causative organism meningitis
strep pneumoniae
127
sx meningitis
- Headache
- Neck stiffness
- Photophobia
- Confusion
- fever
128
treatment for meningitis in adults
viral should self-resolve but bacterial = cefitriaxone or acyclovir
129
sx migraine
- Unilateral, throbbing headache
- nausea, photophobia
- <72hr
- Precipitated by aura 5-60 mins
130
treatment for acute migraine
triptans - serotonin agonists
131
what is MS
autoimmune demyelination in CNS - can be relapsing-remitting, secondary or primary progressive
132
MS sx
- Optic neuritis
- Worsening vision when body temp rises
- Paraesthesia
- Trigeminal neuralgia
- Spastic leg weakness
- Ataxia
- Urinary incontinence
- Sexual dysfunction
133
mx MS
prednisolone
134
causes of CN3 palsy
diabetes, vasculitis, PCA aneurysm
135
sx tension headache
A bilateral ‘tight band’ around the head - not associated with aura/N+V
136
tx tension headache
aspirin/NSAIDs
137
ischaemic stroke
blockage in blood vessel
| Af is risk factor
138
haemorrhage stroke
blood vessels burst = reduced blood flow
139
sx stroke
- motor weakness
- Speech problems
- Dysphagia
- visual field defects
- contralateral hemiplegia
- homonymous hemianopia
140
treatment ischameic stroke
thrombolysis <4.5h
| Aspirin 300mg
141
treatment TIA
aspirin 300mg ASAP
142
anterior cerebral artery stroke
contralateral leg weakness
143
middle cerebral artery stroke
contralateral arm weakness
144
posterior cerebral artery stroke
contralateral agnosia and visual field defects
145
basilar artery stroke
locked in syndrome
146
specific treatment for absence seizures
ethosuximide
